Customer: ___________________________________________________________ Date:____________________
Independent Travel Agent:_____________________________________________ PIN: ____________________
Agent Tel:_______________________ Fax:_____________________ Email:_____________________________
TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases
Thank you for your purchase. InteleTravel.com is pleased to confirm the following travel arrangements. To
complete your transaction and confirm your arrangements, your signature on this authorization is required. This form
is
NOT required for electronic purchases you complete yourself on our website, www.InteleTravel.com
, or its
affiliates. Charges are payable ONLY to InteleTravel.com or the hotel, resort, tour operator, cruise line or other travel
supplier. Independent Travel Agents may not accept and process charges through any other account, or accept
checks, cash or other forms of payment.
TRAVEL INSURANCE WAIVER
For your protection, Travel Insurance is strongly recommended and available upon request from
InteleTravel.com. You can enroll online for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay
or Cancellation, and other coverage, or your InteleTravel.com Independent Travel Agent can arrange coverage for
you. For an online insurance quote and purchase, go to www.InteleTravel.com
and click on Insure It.
To decline recommended travel insurance, your signature on this insurance waiver form is required. Final
Travel Documents (tickets, vouchers, etc.) cannot be sent to you prior to receipt of the signed insurance waiver.
I, _______________________________________________, authorize InteleTravel.com and or this travel supplier:
________________________________________________________________________________, to charge my:
(check one) AMERICAN EXPRESS MASTERCARD VISA DISCOVER
Credit Card Number :________________________________________ Expiration Date:_______________________
Billing Address:____________________________________________ CVV: ______________
_________________________________________________________ For the amount of $ ______________ (USD)
For the following travel arrangements:
Itinerary :______________________________________________________________________________________
Dates of Travel:____________________________________________ Booking Number: :_____________________
Passenger Names :_____________________________________________________________________________
_____________________________________________________________________________________________
PLEASE SIGN ON THE LINE WHICH APPLIES
I have ACCEPTED and authorized the travel purchases above, including travel insurance, and I am aware the
insurance premium is not refundable.
Customer Signature:________________________________________________ Date_______________________
OR
I have ACCEPTED and authorized the travel purchases above, and I understand that by signing below, I am
DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees related to
the above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case
of cancellation of nonrefundable airline tickets or
other arrangements, I agree to pay all applicable penalties
according to the travel supplier’s rules.
Customer Signature:________________________________________________ Date_______________________
IMPORTANT: Please attach a legible copy of the front and back of your credit card.
All rates subject to restrictions, availability and change. See www.InteleTravel.com for complete terms and conditions. InteleTravel.com is
registered with the States of Florida (ST32452) , Washington (602-735-106) and California (2091941-40) as a seller of travel.
© InteleTravel.c
om 2008 110108
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